Ovarian cancer is deadly and generally diagnosed at late stage when the chances of survival are low. There is a current belief that this cancer starts in the fallopian tubes and progresses towards the ovaries, spreading to the cells on the surface. The ovaries are somewhat engulfed in the ends of the fallopian tubes which are designed to capture what is released and transport this into the uterus. While designed to capture the released eggs, the flow created by the follicles will also capture the released proteins and transport them towards the uterine cavity. Within the fallopian tubes and the uterus, there is a constant flow of mucus which has only one exit through the cervix and out the vagina. Proteins that are generated within the entire female reproductive system are trapped into this viscous fluid and eventually released as waste. When a routine PAP test is performed, a sample of this mucus is collected along with any cells, and preserved in the PAP fluid. The fluid is currently discarded but contains a protein profile showing of the status of the cells in the female reproductive system. We have examined this fluid and found that it contains unique peptides/proteins that provide a diagnosis of ovarian cancer when compared against healthy controls. These markers will be initially refined using the comparison of ovarian cancer patients against those with benign adnexal masses that entered the clinic during the same time period. In this Phase II biomarker validation study we will further refine and validate these biomarkers using a new collection of samples from at least 200 ovarian cancer cases with epithelial ovarian cancer (endometroid and papillary serous histology, most common) and comparing these against 600 patients with a diagnosis of a benign adnexal mass that enter the clinics during the same time period. Patient samples will be collected on their first visit to the gynecologic oncologist at a number of collaborating clinics. Final processing of all of the samples will be performed within the proteomics research facilities of the Mitchell Cancer Institute using Selected Reaction Monitoring (SRM, with mass spectrometry) based on the refined set of makers statistically selected within the first aim. We have been working on this approach and collecting samples for four years and filed patents on the approach. Cervicovaginal fluid offers a high enriched sample for discovery and diagnosis of gynecological cancers. Biomarkers validated within this study will be compared with the well accepted CA-125 data for the patients. The potential early detection of ovarian cancer in this restricted proteomic sample is only enhanced by the current belief that ovarian cancer may originate in the fallopian tubes. The research involves a three year validation and may allow detection of this cancer at a very early stage when the survival is as high as 90%. One aim examines a self-taken test that could allow its use in medically underrepresented and rural areas. PUBLIC HEALTH RELEVANCE: Ovarian cancer is generally detected at late stage when the prognosis is poor, and there are no good early detection biomarkers for this fatal disease which, when caught in early stage, can have a 90% 5-year survival rate. This research makes use of biomarkers in gynecological mucus as a screening tool for the early detection of this disease. Initial markers have been established using a limited sample size and this application represents a Phase II validation study using multiple clinics to provide samples.